Aortic arch and common carotid artery plaques with soft components pose a substantial risk of cerebral embolization during carotid stenting

Szikra, Péter; Boda, Krisztina; Rárosi, Ferenc; Thury, Attila; Barzó, Pál; Németh, Tamás; Vörös, Erika

doi:10.1177/1591019916633242

Cited by 9 publications

(15 citation statements)

References 32 publications

(67 reference statements)

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“…reported that while an EPD may provide partial protection of the ICA to be treated, it does not provide protection against contralateral or posterior fossa embolisation originating from the plaques of the aortic arch. 13 In our cases, postoperative DWI high-intensity lesions in the posterior circulation were identified in the two patients without visible OA–VA anastomosis. Although the postoperative DWI high-intensity lesions might have been caused by embolic agents through the posterior communicating artery, it is also possible that they were caused by plaque fragments from the aortic arch through the VA during catheter manipulation.…”

Section: Discussionsupporting

confidence: 54%

“…Szikra et al reported that soft plaques in the aortic arch and CCA could pose a substantial risk of embolisation during CAS. 13 Kim et al reported that manoeuvres in the aortic arch during CAS play an important role in the occurrence of new ischaemic lesions in the posterior fossa and contralateral ICA territory. 14 These reports may suggest that simpler endoluminal device manipulation in the CCA and aortic arch may be safer regarding the peri-procedural ischaemic stroke risk.…”

Section: Discussionmentioning

confidence: 99%

“…reported that soft plaques in the aortic arch and CCA could pose a substantial risk of embolisation during CAS. 13 Kim et al. reported that manoeuvres in the aortic arch during CAS play an important role in the occurrence of new ischaemic lesions in the posterior fossa and contralateral ICA territory.…”

Section: Discussionmentioning

confidence: 99%

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Carotid artery stenting for patients with occipital–vertebral anastomosis

et al. 2018

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Background and purpose We report the outcomes of carotid artery stenting for patients with angiographically visible occipital artery–vertebral artery anastomosis. Methods Among 47 consecutive patients who underwent carotid artery stenting from January 2007 to December 2010, seven patients for whom cerebral angiograms clearly showed occipital artery–vertebral artery anastomosis were selected. Four different protection methods were used: distal internal carotid artery protection; carotid flow reversal; seatbelt and airbag technique; and double protection method of protecting both the external and internal carotid artery. Results One patient with distal internal carotid artery protection showed a high-intensity lesion at the border of the upper thalamus, internal capsule and lateral ventricle wall after carotid artery stenting. The other patient with the double protection method did not show any high-intensity lesions on postoperative diffusion-weighted imaging in the vertebrobasilar territory. All seven patients with visible occipital artery–vertebral artery anastomosis showed ipsilateral vertebral artery severe stenosis or occlusion. Conclusion Large occipital artery–vertebral artery anastomosis may be a pathway for embolic materials during carotid artery stenting. External carotid artery protection is recommended for carotid artery stenting in such patients.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

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Carotid artery stenting for patients with occipital–vertebral anastomosis

et al. 2018

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“…We conducted a systematic literature review without meta-analysis per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [8]. Nineteen studies were identified that discussed perioperative risk in the context of relevant anatomy [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] (Table 1) in addition to fourteen studies [28][29][30][31][32][33][34][35][36][37][38][39][40][41] (Table 2) and fifteen case reports/series [42][43][44][45][46][47][48][49][50][51][52][53][54]…”

Section: Resultsmentioning

confidence: 99%

“…Multivariate analysis was provided in nine series [14,[16][17][18][19][20]22,26,27]. Associated immediate outcomes included the development of post-operative hemodynamic depression (HD), independently predicted by degree of change in pre and post-CAS ICA angulation while plaque morphology and ICA ostium involvement were not significantly associated [26], and the detection of macroscopic intraluminal debris following stent placement, which was predicted by the presence of a heterogeneous echolucent plaque on enhanced carotid ultrasound (CEUS) [27].…”

Section: Studies With Multivariate Analysismentioning

confidence: 99%

Anatomical Considerations for Endovascular Intervention for Extracranial Carotid Disease: A Review of the Literature and Recommended Guidelines

Scullen

Mathkour

Carr

et al. 2020

JCM

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Patient selection for endovascular intervention in extracranial carotid disease is centered on vascular anatomy. We review anatomical considerations for non-traumatic disease and offer guidelines in patient selection and management. We conducted a systematic literature review without meta-analysis for studies involving anatomical considerations in extracranial carotid intervention for non-traumatic disease. Anatomical considerations discussed included aortic arch variants, degree of vessel stenosis, angulation, tortuosity, and anomalous origins, and atheromatous plaque morphology, composition, and location. Available literature suggests that anatomical risks of morbidity are largely secondary to increased procedural times and difficulties in intervention system delivery. We recommend the prioritization of endovascular techniques on an individual basis in cases where accessible systems and surgeon familiarity provide an acceptable likelihood of rapid access and device deployment.

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Three‐dimensional multicontrast blood imaging with a single acquisition: Simultaneous non‐contrast‐enhanced MRA and vessel wall imaging in the thoracic aorta

Tachikawa

Hamano²,

Yoshikai

et al. 2022

Magnetic Resonance in Med

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To evaluate MRA and vessel wall imaging (VWI) image quality in the thoracic aorta using a novel method named BRIDGE (bright and dark blood images with multishot gradient-echo EPI). Methods:The BRIDGE method consists of 3D multishot gradient-echo EPI acquisition using pulse gating, navigator gating, and magnetization preparation with a T 2 -preparation pulse and a nonselective inversion-recovery pulse.The BRIDGE and conventional methods (noncontrast MRA based on 3D turbo-field-echo [TFE] and VWI based on 3D turbo spin echo with variable refocusing flip angle [VRFA-TSE]) were performed in 10 healthy volunteers and 10 patients. The SNR, contrast-to-noise ratio (CNR), and sharpness in the thoracic aorta were compared for MRA evaluation. The values of SNR lumen , SNR wall , CNR wall−lumen , contrast ratio (CR) lumen−muscle , coefficient of variation, sharpness, lumen area, and wall area in the thoracic aorta were compared for VWI evaluation. Two radiologists independently performed qualitative image-analysis assessments.Results: When MRA and VWI were acquired, the acquisition time was 26.6% to 27.8% shorter with BRIDGE than the conventional method. In the MRA evaluation, BRIDGE and TFE methods were comparable. In the VWI evaluation, BRIDGE was superior to the VRFA-TSE method in blood suppression and evaluation of the ascending aorta. Because the blood signal suppression of BRIDGE is based on the T 1 value of blood, the blood signal can be suppressed more uniformly than with the VRFA-TSE method, regardless of age, blood flow velocity, or vascular anatomy. Conclusion:The BRIDGE method can provide both MRA, to assess vascular anatomy and luminal changes, and VWI, to assess the vessel wall and detect vulnerable plaques, in a single scan.

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Aortic arch and common carotid artery plaques with soft components pose a substantial risk of cerebral embolization during carotid stenting

Cited by 9 publications

References 32 publications

Carotid artery stenting for patients with occipital–vertebral anastomosis

Carotid artery stenting for patients with occipital–vertebral anastomosis

Anatomical Considerations for Endovascular Intervention for Extracranial Carotid Disease: A Review of the Literature and Recommended Guidelines

Three‐dimensional multicontrast blood imaging with a single acquisition: Simultaneous non‐contrast‐enhanced MRA and vessel wall imaging in the thoracic aorta

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